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50th Merdeka and 50 years of Medicine in Malaysia

Bernard tagged me in the MMR shoutbox to be next in line for the 50 posts to Independence thingey in celebration of 50th Independence Day of Malaysia.
I was born not that long after 1957 and on a day not far from 31 August. So I can say I grew up with Malaysia as a nation and have seen it grow and develop to what it is today.

I’ll focus on healthcare and medicine as after all, this is what the MMR is all about. Speaking of MMR, I am sure some of you are not to young to remember another MMR – Mass Miniature Radiography – where vans with portable Xray machines went round screening people for Tuberculosis. Radiology Malaysia has mentioned this in A Brief History of Radiology in Malaysia. Apart from TB, there was also crippling poliomyelitis and “tropical” diseases like malaria, cholera, typhoid which were more rampant in earlier years.
Leprosy was so common there were leper colonies in Pulau Jerejak (now a penal colony) and in Sungei Buloh (now a modern hospital with a focus on infectious diseases). Poliomyelitis has now been eradicated with the advent of mass immunisation.
However in recent years we have seen new challenges in the form of emerging infections like SARS, H5N1 Avian Flu and Nipah virus. Luckily Malaysian Medicine has risen to the challenge. I can’t imagine the consequences if it were not for the perseverance of men like Dr. Chua Kaw Bing. Nevertheless we still can’t shake off the threat of infection without good public health measures. 50 years on we still see TB as a threat and urbanisation sees a perpetual dengue endemic.

Infectious diseases aside, the main challenges we face are “modern” problems like Cardiovascular diseases and Cancer. With these comes the high cost of treatment (bypass surgery, anigioplasty, heart transplants, cancer chemotherapy, expensive new “targeted” drugs) maintaining expensive equipment and what not. The Government feels the pinch when it comes to healthcare spending but reallly, if one can think of spend hundreds of millions building sports complexes overseas or if the “commission” from purchase of military equipment comes to millions as well, think of how that money instead could have been spent on healthcare of the populace! So 50 years on we still spend very little on healthcare , a measly 3% of the GDP or so. The Government has still not implemented a National Health Insurance scheme and plans are still in place to “corporatise” and “privatise” public healthcare bit by bit.

Things may have gone a little astray in trying to cope with the demands of 21st century medicine, but has our public health system become a nightmare? It’s sad to read of Sick hospitals and Problematic ambulance services. While there are grandiose plans for “teleconsultation” perhaps we should take humble steps to implement IT properly in our public hospitals, most of which don’t have the benefit of simple things like online access to lab results, something taken for granted in hospitals in the UK and Australia. We need to Get the basics right first.

I think our country’s healthcare system, after 50 years of independence is now at a cross-roads, middle-age crisis as it were. This country is not poor and we can afford better healthcare for the people We need to stamp out corrupt and greedy people who only seek to plunder the country’s riches. We need to reward the people manning the healthcare services appropriately. After 50 years, a public doctor’s salary has not kept up with inflation and indeed continues to slide further below market reality. Well, after 50 years, we still see doctors leaving. It’s not just the salary but the poor working conditions and the lack of fair promotion opportunities which has not been adequately addressed. After 50 years, we still don’t have an attractive system to ensure those training abroad will be coming home.

When the first medical school established in Malaysia (the University of Malaya) we could be proud of her medical graduates many of whom have become fine doctors including leaders in their field in prestigious institutions abroad. Today we have close to 20 medical schools, yet one wonders if standards are declining if the senior teachers have left and academic staff are shorthanded and relatively young and inexperienced? The Government’s plan to “flood the market” with doctors in order to address a shortage has a serious flaw – you need also to contend with and maintain standards. So now, we are talking about a Common Qualifying Exam for medical graduates .

I’ll conclude this rambling with my 50th Merdeka wishes:

1) The citizens of the land stop being apathetic and be part of the solution. Be aware of issues like the forthcoming NHIS and what’s in store for us. Be active and participate constructively in interest groups like the CAHP. I hope the leaders of the land eventually implement a just NHIS. We don’t want to end up being another Sicko country.
2) The medical professional bodies in the country must once again focus on the really important issues. What matters at the end of the day are that we must maintain professional ethics and standards. If we fail in this area then we have lost the game. Will the MMA rise to the challenge?
3) We have to develop our underdeveloped culture of research, clinical trials and biotechnology. We can only do this if you retain the best brains and talent. We need to work together for the whole nation and not just for one’s own race and religion. You can build Biovalleys but without the talent you just have a Valley of Ghosts.
4) The MOH get serious and maintain vigilance and crackdown hard on medical fraud in this country. We not only have so much false claims and false advertising, we have herbal products manufactured in Malaysia tainted with potent substances. We have medical practitioners who practice quack medicine like ozone therapy. We on our part will continue the Fraud Watch
5) If the MOH wants to go down the path of incorporating TCM in public hospitals, they must ensure every aspect is evidence based. After all, if you are spending money on employing these alternative medicine people, it’s the citizen’s tax money being used. I sincerely hope it is being used wisely.
6) Can we put a stop to these sick hospitals and sick ambulances already! I say enough of the bocor and the close-one-eye politicians! Vote wisely in the forthcoming elections! If the politicians and the leaders of the day are not doing their job, it’s time for a change.

Who should I pass the 50 posts to Independence torch to? D’s day chair hydraulics gave problems yesterday. I wonder how many physically challenged people in this country today are struggling with their everyday lives. I wonder after 50 years of independence, how has this country progressed when it comes to people who are physically and/or mentally challenged? How do our social services stack up when compared to developed nations? How handicapped friendly are our buildings, pavements, transport systems today?
I’d like to pass the torch to Peter Tan

Here are the posts in this project so far:

50, 49, 48, 47, 46, 45, 44, 43, 42, 41, 40, 39, 38, 37, 36, 35, 34, 33, 32,31, 30, 29, 28, 27, 26, 25, 24, 23, 22, 21, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9 – this is it,8,7,6,5,4,3,2,1

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5 Responses to “50th Merdeka and 50 years of Medicine in Malaysia”

  • UK Doc says:

    Wow, Palmdoc, I really enjoy reading this article very much. I hope some of your wishes will come true soon.

  • Hands says:

    This is a great write up, Palmdoc. And a call to action! 🙂

  • lulai says:

    yeah good write up, doc! glad bernard passed this to you – a doctor and now you are passing it to peter tan. this merdeka post will be very meaningful only if there are people with diverse background writing.

    btw, how do you put in the all the posts in nos.? you have the code to do it? can send me the code or not?

  • Palmdoc says:

    Thanks guys. Sorry I couldn’t do better but I had like 24 hours notice 😛 There’s like 7 weeks left to Merdeka for the 8 remaining posts, so it’s less than a weeka post.

    Anyway if anyone wants the html code for the 50 posts ilnks so far, you can download it here:
    http://medicine.com.my/upload/50posts.zip

  • Palmdoc says:

    In the Star article entitled “Healthy growth“, the Minister was quoted as saying

    In recent years, the health system has been severely tested as it dealt with cases involving the Japanese Encephalitis (JE) virus, Nipah virus and SARS. But these have only made the ministry even more prepared for other threats.

    What JE outbreak? The handling of the Nipah outbreak was atrocious IMO. It was mislabeled by the former Minister as JE when it was not. Pigs were wrongly vaccinated against JE and farmers were sent back to the farms mistaken that they were “protected”. Only the culling of the pigs stemmed the outbreak.
    What SARS outbreak in Malaysia? We were darn lucky the outbreak petered out before it crossed the causeway. If it had, then our health services would have been really severely stressed.

    The reporter failed to really “stress” the Minister on querying what of the sick MOH hospitals, sick ambulances, the plunge into TCM etc.

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